Medicine Man Pharmacy-Brazoria LLC
Organization Active NPI Community/Retail Pharmacy · Brazoria, TX
NPI 1679932297 · NPPES record last updated May 23, 2016
Key facts
- NPI
- 1679932297
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 30626 (TX)
- Legal business name
- MEDICINE MAN PHARMACY-BRAZORIA LLC
- Practice address
- 102 E San Bernard St
A
Brazoria, TX 77422-5647 - Phone
- (979) 798-4800
- Fax
- (979) 798-4803
- NPI assigned
- Feb 11, 2016
- Organization subpart
- No
Authorized official
- Name
- Bruce W Rogers, R.PH.
- Title
- Owner
- Phone
- (979) 798-4800
Practitioners 1
National Provider Directory
Locations
102 E San Bernard St
#A
Brazoria, TX 77422
Phone (979) 798-2111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 30626 | TX | Yes |
Addresses
Primary practice location
102 E San Bernard St
A
Brazoria, TX 77422-5647
Mailing address
PO Box 3670
Victoria, TX 77903-3670
Phone (979) 798-4800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30626 | Other | TX | TEXAS STATE BOARD OF PHARMACY |
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- John D Hall
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- Mindful Wellness and Recovery
- Jennifer Mullis
- Adam Paul Osga
- Linda Janet Pearson
- Gabriela Polanco
All providers in Brazoria, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.